BACKGROUND: The major risk factors such as hypercholesterolemia, hypertension, diabetes melitus and cigarrete smoking have not been studied in an attempt to provide a composition of major risk factors in Korea. Also we have met with some patients without major risk factors. METHODS: A Retrospective Study was done on 160 patients of acute myocardial infarction who had been admitted to National Medical Center within 48 hours from onset, from January 1948 to December 1992 and studied on major risk factors of acute myocardial infarction. RESULTS: 1) Among major risk factors, smoking was found in 50%, hypertension in 49%, diabetes in 25% and hypercholesterolemia in 21%. 2) The percentage of patients without major risk factors was 19%. 3) Among major risk factors, hypertension, hypercholesterolemia and diabetes were increasing tendencies, recentely. CONCLUSION: Some patients with acute myocardial infarction don't have any major risk factors. Also hypertension, hypercholesterolemia and diabetes were increasing tendencies. So further study for other risk factors is needed and preventive management should require a commitment to behavior modification and alteration in life-style.
Behavior Therapy ; Humans ; Hypercholesterolemia ; Hypertension ; Korea ; Myocardial Infarction* ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking

BACKGROUND: During coronary angiography, some electrocardiographic changes occured due to contrast media, which do life threatening influences. METHODS: We compared the electrocardiographic changes which were induced by injection of three radiopaque contrast media during selective coronary angiography in 49 patients with chest pain. One of the contrast media was high osmolar ionic(Urografin_76) and the another was low osmolar ionic(Hexabrix) and the last was non-ionic(Ioversol). Electrocardiograms were obtained before, during and after selective coronary angiography. RESULTS: The changes of S-T segment or T were decreased in non-ionic group rather than high osmolar or ionic group. And there was significant Q-Tc interval prolongation among all three groups except comparision of low osmolar ionic contrast dye and non-ionic contrast dye in left coronary angiography. CONCLUSION: Non-ionic low osmolar contrast media was safer than high osmolar or ionic contrast medial because of lesser change of Q-Tc interval during selective coronary angiography.
Chest Pain ; Contrast Media* ; Coronary Angiography* ; Diatrizoate Meglumine ; Electrocardiography* ; Humans ; Ioxaglic Acid ; Osmolar Concentration

BACKGROUND: Observation on the hemodialysis treatment; whether there are any different effects on mortality rate, side effects, or effectiveness of the treatment depending on patients' age. METHODS: Chronic renal failure patients who started hemodialysis treatment between 2002 and 2003 were separated in two groups, 33 patients of 60 and older and 76 patients under 60. We investigated mortality rate difference, A-V shunt re-operation, and total protein and albumin level. Also, comparing and analyzing the urea reduction ratio, we examined whether effectiveness is different depending on the patients' age. RESULTS: The 3 year survivor rate of patients who initially started hemodialysis treatment over 60 was 66.7%, and that of the patients under 60 resulted as 73.1%. The average total protein lefel for over 60 was 6.48g/dL and for under 60 was 6.80g/dL, and albumin for over 60 was 3.15g/dL and under 60 was 3.46g/dL. We identified that the patients who repeated shunt operation in over 60 group was 4(12%) and in under 60 group was 4(5.2%). Effectiveness of the treatment, Urea Reduction Ratio(URR), for both groups was 71%. CONCLUSION: The 3 year survivor rate of patients who initially started hemodialysis treatment over 60 was lower than the control group, but considering the remaining life expectancy, it seems to be no significant difference between the groups; and the treatment effectiveness was same in both groups.
Humans ; Kidney Failure, Chronic ; Life Expectancy ; Prognosis ; Renal Dialysis ; Survivors ; Treatment Outcome ; Urea

BACKGROUND: Because difficult airways are not commonly encountered, simulation of a difficult airway using a cervical collar has become a well-established technique of for modeling difficult laryngoscopic views and evaluating interventions for use in difficult airway scenarios. In this study, we have determined the optimal remifentanil concentrations (EC50 and EC95) required for i-gel insertion in anesthetized patients fitted with cervical collars at propofol effect-site concentrations of 4.0 and 6.0 microg/ml (group 4.0 and group 6.0). METHODS: The remifentanil dosage for each propofol effect-site concentration group was determined by the modified Dixon's up-and-down method using previous results. The experiment was started using a 4.0 ng/ml effect-site remifentanil concentration, and the dose was reduced by 0.5 ng/ml for the next attempt when tube insertion was successful; if tube insertion failed, the dose for the next attempt was increased by 0.5 ng/ml. RESULTS: EC50 and EC95 were respectively 2.11 ng/ml (95% CI, 1.78-2.26 ng/ml) and 2.44 ng/ml (95% CI, 2.28-3.67 ng/ml) for the 4.0 group, and 0.42 ng/ml (95% CI, -1.30 to 0.77 ng/ml) and 0.75 ng/ml (0.56-14.3 ng/ml) for the 6.0 group. CONCLUSIONS: In this study, a cervical collar was attached and head fixation was performed to induce a difficult airway. The optimal concentration of remifentanil at a propofol effect-site concentration of 4.0 microg/ml was greater than 2.44 ng/ml (95% CI, 2.28-3.67 ng/ml), and that at the propofol effect-site concentration of 6.0 microg/ml was greater than 0.75 ng/ml (0.56-14.3 ng/ml).
Head ; Humans ; Propofol

A 33-year-old male visited the emergency room with abdominal pain which developed after a vomiting episode. Based on the pneumomediastinum findings from a chest radiograph and a contrast-enhanced chest and abdominal computed tomography scan, the patient was diagnosed with Boerhaave's syndrome. Preoperative radiologic findings showed no pneumothorax or pleural effusion. Once anesthesia was administered, the patient developed near complete cardiopulmonary collapse due to a bilateral tension pneumothorax, which was treated by bilateral thoracentesis, followed by chest tube insertion. Despite a left side rupture, the damaged right lung was unable to overcome single right ventilation, so the surgery was completed via right thoracotomy. The ruptured site was treated, and the patient was transferred to the intensive care unit. We discuss the anesthetic implications of this disease and how to prevent fatal complications.
Abdominal Pain ; Adult ; Anesthesia* ; Anesthesia, General ; Chest Tubes ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Lung ; Male ; Mediastinal Emphysema ; Pleural Effusion ; Pneumothorax* ; Positive-Pressure Respiration ; Radiography, Thoracic ; Rupture ; Thoracotomy ; Thorax ; Ventilation ; Vomiting

BACKGROUND: The glomerulonephritis appears in various clinical presentations. Renal biopsy is important diagnostic tool for treatment decision and prognosis prediction of glomerulonephritis. We tried to study on the clinical presentations of glomerulonephritis through histopathological findings and treatment responses in elderly patients. METHODS: We made an retrospective analysis in elderly patients aged over 60 years performed renal biopsy in our medical center from January 1991 to February 2005. RESULTS: Of all the 42 patients, the mean age of the patients was 64.6+/-3.5 years, 24 male and 18 female patients were included(1.3:1). Patients aged 60-64 years (n=26, 62%) were majority. On clinical indications of renal biopsies, 17 patients had nephrotic syndrome, 10 had asymptomatic urinary abnormality, 5 had gross hematuria, and 5 had acute azotemia. The results of renal biopsies presented that 30 patients (71%) had primary glomerulonephritis, 9 patients (22%) had secondary glomerulonephritis. Among primary glomerulonephritis, membranous nephropathy (n=10) was most common, followed by IgA nephropathy (n=7),focal segmental glomerulos-clerosis (n=3), membranoproliferative glomerulonephritis (n=2), and mesangioproliferative glomerulonephritis (n=2). In secondary glomer-ulonephritis, there were diabetic nephropathy (n=2), lupus nephritis (n=2), cancer-related nephritis (n=2), poststreptococcal glomer-ulonephritis (n=1), Henoch-Schonlein nephritis (n=1), amyloidosis (n=1). In the cases of nephrotic syndrome, primary nephrotic syndrome (n=12, 71%) is more prevalent than secondary nephrotic syndrome (n=3, 18%). The most common cause of primary nephrotic syndrome was membranous nephropathy (n=8). The causes of asymptomatic urinary abnormality were IgA nephropathy (n=4), lupus nephritis (n=2), membranous nephropathy (n=1), mesangioproliferative glomerulonephritis (n=1). By the complications of renal biopsy, only a few patients presented new-onset hematuria, hematoma, aggravation of hypertension, but, severe complication including an infection or a death was none. 8 of 12 patients with primary nephrotic syndrome were treated, 5 patients of those were shown complete response (n=3) or partial response (n=2). CONCLUSION: Various clinical presentations of glomerulonephritis were shown to elderly patients. Number of complications after renal biopsies were relatively small, and good responsiveness to treatment could be expected in the elderly patients. Therefore it is reasonable to perform a renal biopsy if indicated.
Aged* ; Amyloidosis ; Azotemia ; Biopsy ; Diabetic Nephropathies ; Female ; Glomerulonephritis* ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematoma ; Hematuria ; Humans ; Hypertension ; Lupus Nephritis ; Male ; Nephritis ; Nephrotic Syndrome ; Prognosis ; Retrospective Studies

BACKGROUND: Besides its general anesthetic effect, ketamine interacts with sodium channels in a local anesthetic-like fashion, including the sharing of binding sites with those commonly used by clinical local anesthetics. This study evaluated the dose related effects of ketamine during epidural anesthesia with 0.5% ropivacaine. METHODS: Sixty ASA physical status I-II patients, scheduled for minor elective surgery under epidural anesthesia using 0.5% ropivacaine, were randomly divided into three groups (n = 20 each). The patients initially received either 0.5% ropivacaine (group 1), ketamine (0.1 mg/kg) in addition to the epidural 0.5% ropivacaine (group 2) or ketamine (0.2 mg/kg) in addition to the epidural 0.5% ropivacaine (group 3). The regression of sensory block was assessed by transcutaneous electric stimulation (TES), equivalent to a surgical incision. Motor block was assessed using the Modified Bromage's scale. Episodes of bradycardia, hypotension and sedation were also recorded. RESULTS: There were no significant differences among the three groups in the maximal levels of sensory block or the times taken for these levels to be reached. The mean times for the block to regress to two and four segments below the maximal level were significantly prolonged by epidural ketamine. CONCLUSIONS: Epidural ketamine prolongs the duration of ropivacaine epidural anesthesia. These results suggest that ketamine has local anesthetic-like actions.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Binding Sites ; Bradycardia ; Humans ; Hypotension ; Ketamine* ; Sodium Channels ; Transcutaneous Electric Nerve Stimulation

Dermatomyositis is a clinical syndrome of unknown etiology characterized by a nonpurulent inflammatory myopathy involving striated skeletal muscle associated with rheumatoid arthritis, or systemic lupus erythematosus, sometimes underlying malignancy. A few cases of acute renal failure due to rhabdomyolysis in dermatomyositis has been reported. But, no case combined with breast cancer have been reported. We experienced a case of acute renal failure due to rhabdomyolysis associated with dermatomyositis. The patient was admitted to the our hospital due to breast cancer. After breast cancer operation, she complained of progressive muscle weakness. The heliotrope rash involved the eyelid, bridge of nose and forehead. And eczematoid dermatitis involved the lower abdomen and both forearm and hands. The laboratory findings revealed LDH 2,944IU/L, CPK 2,244IU/L and SGOT 214IU/L. Serum myoglobin and aldolase were increased, and antinuclear antibody was 1:40(positive, homogenous pattern). Electromyogram revealed myopathic findings compatible with dermatomyositis. Then, the patient developed acute renal failure requring hemodialysis. After acute hemodialysis, acute renal failure resolved. But, the patient died on the 113th hospital day due to sepsis. Here, we report a case of acute renal failure due to nontraumatic rhabdomyolysis associated with dermatomyositis in breast cancer.
Abdomen ; Acute Kidney Injury* ; Antibodies, Antinuclear ; Arthritis, Rheumatoid ; Aspartate Aminotransferases ; Breast Neoplasms* ; Breast* ; Dermatitis ; Dermatomyositis* ; Exanthema ; Eyelids ; Forearm ; Forehead ; Fructose-Bisphosphate Aldolase ; Hand ; Humans ; Lupus Erythematosus, Systemic ; Muscle Weakness ; Muscle, Skeletal ; Myoglobin ; Myositis ; Nose ; Renal Dialysis ; Rhabdomyolysis* ; Sepsis

BACKGROUND AND OBJECTIVES: In Kawasaki disease (KD), high dose intravenous immunoglobulin (IVIG) significantly lowers the coronary complications. However, some patients either do not respond to initial therapy or develop coronary complications. We aimed to identify the predictive factors for unresponsiveness to initial IVIG therapy and coronary artery dilatation (CAD; defined by Z-score≥2.5) in the acute phase and convalescent phase. SUBJECTS AND METHODS: A retrospective review was conducted of 703 patients with KD, admitted to Gachon University Gil Medical Center between January 2005 and June 2013. The patients were divided into two groups-IVIG responders vs. non-responders-based on the IVIG treatments, and presence of fever after treatment. Further, these groups were divided into two subgroups based on their CAD. RESULTS: Among the 703 patients with KD, the rate of non-responders to initial IVIG was 16.8%. Serum total bilirubin, platelet count, and neutrophil proportion were independent predictive parameters of unresponsiveness (p<0.05). CAD was found in 234 patients (33.3%) in the acute phase, and in 32 patients (4.6%) in the convalescent phase. Male gender, fever duration, serum C-reactive protein, and white blood cell count were related to CAD (p<0.05). CAD was detected more frequently in non-responders than in the responders (47.5% vs. 31.5%, p=0.001). Kobayashi, Egami, and Sano scoring systems applied to our study population reflected low sensitivities (28.0-33.9%). CONCLUSION: Several independent parameters were related to unresponsiveness to the initial IVIG or CAD. These parameters might be helpful in establishing more focused and careful monitoring of high-risk KD patients in Korea.
Bilirubin ; C-Reactive Protein ; Child* ; Coronary Vessels* ; Dilatation* ; Fever ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Korea ; Leukocyte Count ; Male ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils ; Platelet Count ; Retrospective Studies

We experienced a malignant hyperthermia in 24-year-old male with sevoflurane during the mandibular prognathism surgery. The malignant hyperthermia emerged 150 minutes after induction of general anesthesia using propofol, rocuronium, sevoflurane, N2O and O2. Sevoflurane has been reported that it can induce delayed onset of malignant hyperthermia under absence of succinylcholine. The prognosis of malignant hyperthermia is determined by early recognition, vigorous treatment and the time of dantrolene injection. In our case, when we suspected episode, all anesthetics were stopped and dantrolene injection was immediately given intravenously. The patient recovered normal temperature and consciousness without any complication.
Anesthesia, General* ; Anesthetics ; Consciousness ; Dantrolene ; Humans ; Male ; Malignant Hyperthermia* ; Prognathism ; Prognosis ; Propofol ; Succinylcholine ; Young Adult